Exposure-based treatment offers the best form of therapy for dealing with trauma caused by a tragic death

Exposure-based treatment offers the best form of therapy for dealing with trauma caused by a tragic death says Stephen Fleming, a York University Professor and clinical psychologist.

Fleming and his team of York researchers are investigating the relationship between bereavement and other psychological difficulties when grieving a significant loss. Such losses may include a spouse, child, parent, sibling, close relative or friend and may involve a horrific situation such as a murder, car accident or house fire.

Coping with the tragic death of a loved one

“Following the death of a loved one, people’s grief manifests itself in many ways including depression, anxiety and trauma or a combination of these three, depending on the circumstances surrounding the death,” explains Fleming, who is best known for the course he teaches at York on the psychology of death and dying. “While death and dying are a normal part of everyday life, coping with an unexpected or accidental death can be much more difficult and have longer-term emotional consequences.”

Fleming, who also runs a grief counselling practice in Brampton, Ont., says that trauma symptoms may include painful flashbacks and result in avoiding certain situations, such as driving on the 401, in the case of a fatal car accident, or feeling vulnerable and frightened, in the case of the abduction and murder of a child. “Trauma can occur as a result of witnessing a death or even imagining the grim details second hand – for example, learning about a tragic death through the media which can affect one’s view of the world and of human nature.”

“The best way to deal with trauma is to relive the moment, not avoid it,” says Fleming. “In the case of witnessing a death, clients during psychotherapy are encouraged to recall and relive unpleasant sights, smells and sounds associated with the trauma experience.”

Subway operators, train engineers and tow truck drivers at high risk for trauma

Fleming adds that people in certain occupations -- subway operators, train engineers and tow truck drivers -- are especially prone to trauma symptoms. “We need to understand that it’s not just emergency services workers such as firefighters, police and paramedics that encounter death on the job,” says Fleming. “Subway operators strike people who jump or are pushed into the path of their trains and tow truck drivers are often the first on the scene of a tragic motor vehicle accident.”

Fleming recalls the day when a railway engineer entered his practice. “He summarily declared that he had killed three people – alluding to the fact that there was nothing he could do to stop his train in time for a car that had entered a level crossing despite warning signals.”

Who counsels the grief counsellor?

Speaking from personal experience, Fleming concedes that grief counsellors are often impacted by the problems of their clients who recount their tragic experiences so vividly. “To some degree, you absorb the tragedies of your clients and imagine yourself in their shoes. It’s hard not to be affected over time in some way. It really makes you appreciate the precariousness and preciousness of life. The issue of who counsels the grief counsellor is also becoming a major concern within the profession,” he says.

Teaching the psychology of death and dying

Fleming’s York course on the psychology of death and dying is always enrolled to capacity. Students have the opportunity to visit funeral homes, palliative care units and to interact with many guest speakers, including bereaved parents. “Students often want to discuss their own fears and concerns in the class. In addition to helping them become future potential clinicians, the course helps them cope on a more personal level when they have to deal with the death of a loved one.”

Fleming is organizing a conference scheduled for winter 2005, “The Changing Face of Grief: Time, Trauma, and Transformation”.